Mathieu E, Dufour P, Ernoult P, Prolongeau J F, Vinatier D, Ducloy J C, Tordjeman N, Martin de Lasalle E, Monnier J C
Service de Gynécologie-Obstétrique, Maternité du Pavillon Victor-Olivier, CHRU de Lille.
Rev Fr Gynecol Obstet. 1995 Apr-May;90(4):228-32.
The authors report a case of rupture of the uterus 22 weeks after the LMP, due to placenta praevia percreta and requiring emergency hysterectomy to arrest bleeding, followed by urinary complications. With the predisposing factors of the scars of 4 previous cesarean sections and the low anterior insertion of the placenta, this exceptional case--in terms of its rarity and gravity--led the authors to undertake a review of the literature seeking other cases of this greatly feared obstetric complication. They review the clinical, ultrasonographic (notably the use of color Doppler) and paraclinical (MRI, cystoscopy) diagnostic approach necessary to make an accurate diagnosis of placenta percreta (if possible before any hemorrhagic complications). This situation virtually invariably requires hysterectomy to arrest bleeding, under very difficult conditions because of the massive hemorrhage involved. Mortality remains high and morbidity principally concerns the urinary complications frequently encountered.
作者报告了一例末次月经后22周子宫破裂的病例，该病例因穿透性前置胎盘导致出血，需行急诊子宫切除术止血，术后出现了泌尿系统并发症。鉴于患者有4次剖宫产史形成的瘢痕以及胎盘低前位植入这些易感因素，就该病例的罕见性和严重性而言，实属特殊情况，这促使作者对文献进行回顾，以寻找其他这种令人极为恐惧的产科并发症的病例。他们回顾了准确诊断穿透性胎盘（若可能，在任何出血并发症发生之前）所需的临床、超声检查（尤其是彩色多普勒的应用）及辅助检查（磁共振成像、膀胱镜检查）方法。这种情况几乎总是需要在因大出血而极为困难的条件下行子宫切除术来止血。死亡率仍然很高，发病率主要涉及常见的泌尿系统并发症。
